LECTURES

The paper considers the specificity of using valproic acid (VA) preparations in young childbearing-aged women with epilepsy and discusses the clinical situations of practical application of valproates during pregnancy in view of the baseline efficiency of therapy, the type of epileptic seizures, and the form of epilepsy. It provides a few scenarios of the course of pregnancy and possible treatment policy. Owing to its multiple mechanism of action, VA has been effectively used to treat idiopathic (generalized/focal) cryptogenic and symptomatic focal epilepsies in patients of different age groups, including in childbearing-aged women. It is also effectively used to treat manias in the pattern of bipolar disorders and to prevent migraine. The range of action (the efficiency against different types of seizures and forms of epilepsy), good tolerance, a minimal aggravation risk, high continuous therapy rates, various drug dosage forms, including long-acting or intravenous formulatons, and favorable pharmacokinetic and pharmacodynamics profiles make VA indispensable at the present developmental stage of epileptology. However, VA has definite limitations: the drug is contra-indicated in some forms of mitochondrial encephalopathies; its prescription to young women requires comprehensive assessment of possible therapy consequences, especially in pregnancy planning, the drug should be used with extreme caution in the first trimester of pregnancy. The ideal variant of VA prescription in young women of fertile age is monotherapy, by using its minimal effective daily dose and sustained-release formulations.

ORIGINAL INVESTIGATIONS

Objective: to identify the factors influencing the stigmatization in patients with epilepsy.Patients and methods. The investigation enrolled 71 epileptic patients aged 14 to 50 years. They were divided into two age groups: 30 adolescents aged 14–17 years and 41 adults aged 18–50 years.Results and discussion. Examinations of 71 patients with epilepsy could identify 4 factors influencing their stigmatization: individual traits; activity and relations in the group; the effect of a drug and its adherence in patients; relationships in the family and its response to the disease. The authors’ new screening procedure was employed to determine the leading causes of stigmatization for each age group and to show differences in the specific features of stigmatization (the leading factor of stigmatization) in patients of different age. The major factor of stigmatization in the epileptic adolescents was found to be relationships in the family and its response to the disease. Its chief cause in the adults was their principal activity (studies at a higher education establishment or work) and group relations. The epileptic patients were shown to need psychological care. The developed screening procedure will be useful in planning psycho-correction measures and rehabilitation programs.

Epileptiform EEG changes are much more common in children whose parents are epileptic than in the population. There is evidence that subclinical epileptiform activity affects children’s intellect and behavior. These changes need timely detection and therapy.Objective: to determine the specific features and rates of EEG abnormalities in children born to parents with epilepsy.Patients and methods. The brain bioelectrical activity of 47 children born to epileptic fathers, 53 children born to epileptic mothers, and 46 children born to healthy parents (a control group) was evaluated via video EEG monitoring method on an Encephalan 9 apparatus (Medicom MTD, Taganrog, Russia). Results and discussion. Epileptiform EEG activity was significantly more frequently recorded in the children born to epileptic patients than in the control children. There was no significant difference in the detection rate of epileptiform activity in the groups of children, whose parents had epilepsy. EEG changes were significantly more common in children whose parents had idiopathic generalized epilepsy. The children born to epileptic mothers were more often recorded to have impaired bioelectrical activity of organic nature as a regional continued deceleration of basic activity and its deceleration in the background recording. Epileptiform activity was subclinical in the majority of cases. At the same time, it was unaccompanied by clinical manifestations in all the control children. Regional epileptiform activity was predominant in the study and control groups.

Idiopathic occipital epilepsy is a rare epileptic syndrome. Its incidence in a Novosibirsk cohort of patients with idiopathic focal epilepsy is 0.9%. Objective: to present a clinical description of new cases of Gastaut syndrome, the types of its course, and treatment options in these patients. Patients and methods. The study covers 17 cases of Gastaut type idiopathic occipital epilepsy in 13 women and 4 men aged 11–53 years. Results. Among 17 cases we present 4 family cases with the disease. Three generations in 2 families were observed to have epilepsy, including Gastaut syndrome concurrent with childhood absence epilepsy. The adolescent onset of the disease was seen in most cases. Its main symptoms were focal visual seizures (100%), focal sensory seizures (58.9%), cephalalgia (47.1%), speech disorders (41.2%), and secondarily generalized convulsive seizures (35.3%). According to the frequency of seizures, the investigators identified 5 types of the course: single focal seizures, rare focal seizures with or without convulsions, frequent focal seizures with or without convulsions. The identity of the course of epilepsy was found in familial cases. 76.5% of the patients had a good quality of life: 41.2% of them were untreated while 35.3% were treated; no seizures were noted.

Object: to assess a relationship between febrile convulsions (FC) and epilepsy.Patients and methods. The role of perinatal hereditary diseases, a family history of FC and epilepsy, as well as clinical findings and the results of supplementary studies (electroencephalography and brain magnetic resonance imaging) were analyzed in children with a history of FC. One hundred and sixty-three children with a history of FC were followed up for 8 to 12 years. Two groups of children with transition of febrile convulsions to epilepsy (n=24) and with a good outcome (n=139) were compared.Results and discussion. The findings suggest that factors, such as a family history of epilepsy, the focal pattern of FC, and neurologic changes, highly significantly affect the transformation of FC to epilepsy. Changes in epileptiform EEG activity and abnormal structural neuroimaging are markers for the high probability of transition of febrile convulsions to epilepsy.

Objective: to optimize patient management tactics and disease prognosis, by detecting the regularities of the course of epilepsy during various age periods.Patients and methods. The results of following up 1632 patients with epilepsy in the Samara Region were given. Among them, there were 865 (53.0%) men and 767 (47.0%) women. The classification of epilepsy and epileptic syndromes (New Delhi, 1989) was used to establish the diagnosis. Each patient underwent neurological evaluation, electroencephalography (EEG) and video-EEG monitoring, studies of long-latency visual evoked potentials, as well as neuroimaging examinations (brain computed tomography and magnetic resonance imaging (MRI)). Factor and principal component analysis and logistic regression were used to make a mathematical model to predict remission in epilepsy. Results. The specific features of the occurrence and course of epilepsy in various age periods were analyzed. According to the results of mathematical simulation, the age at the onset of late epilepsy can be considered to be 29 years. Remission of epilepsy was more frequently attained and absolute resistance was less frequently observed in the younger age group, except for infants with catastrophic epilepsy and epileptic syndromes. There were fewer remissions and much more patients with relative and absolute resistance and rare seizures in the older age group. Epilepsy in young patients is that of the immature brain and epilepsy of adulthood (late epilepsy) of the involutional brain. Conclusion. Epilepsy runs a benign course in patients who fell ill in adolescence or adulthood and have minimal brain structural changes, as evidenced by MRI. Marked brain morphological changes most frequently determine the drug-resistant course of epilepsy, manifesting in early childhood and at an elderly age.

Objective: to assess the sociosanitary characteristics of pregnant women with epilepsy at the present stage of public health development, by using the Krasnoyarsk Territory as an example.Patients and methods. Delivery records were retrospectively analyzed in 99 women with different forms of epilepsy who had delivered at Krasnoyarsk Maternity Hospital Five specializing in care for women with CNS disease and in 100 non-epileptic women (in the period 2005–2012). Results. A present-day pregnant epileptic woman is an urban resident aged 25.57±4.64 years who has secondary or secondary vocational education, is married, unemployed, a smoker, and has Disability Group II or III due to the underlying disease.Conclusion. At the present stage of health care development, the portrait of an epileptic woman has changed due to the democratization of society, the reduced stigmatization of the disease, and the emergence of new antiepileptic drugs with low teratogenic effects.

Objective: to evaluate the efficacy and tolerability of levetiracetam (LEV) (epiterra, TEVA) in adult patients with focal epilepsy (FE) or juvenile myoclonic epilepsy (JME) who took the drug for і6 months as of December 15, 2014.Patients and methods. The efficacy of LEV as a generic (epiterra) used in monotherapy was analyzed in 23 patients with FE and in 4 female patients with JME who had taken the drug for ≥6 months. In FE, LEV was switched to epiterra because of the high cost of the former and inadequate efficacy/poor tolerability of initial antiepileptic drugs (AEDs) in 17 and 6 cases, respectively. In JMA, epiterra was prescribed as initial therapy in 2 cases and, with the diagnosis being changed, in 2 more patients. Results and discussion. When LEV was switched to its generic, the indicators of efficacy, tolerability, quality of life, and a plain electroencephalogram (EEG) were significantly unchanged. When epiterra was substituted for other AEDs, the efficiency of its therapy was also significantly unchanged and tolerance, quality of life, and EEG characteristics were improved. Epiterra’s adverse reactions as sleepiness (n = 1) and a higher rate of mental processes (n=1) were observed exclusively when it was switched from another AED. However, they were transient (for 2–3 weeks) and seen during either dose adjustment or at the stage of transitional combined therapy. Dual therapy (valproate + epiterra) had to be used in only 1 female patient.

Thus, the 6-month use of epiterra in adult patients with FE as an alternative to brand LEV did not deteriorate the clinical picture of the disease (remission rates and injury frequency and severity were significantly unchanged) baseline tolerability, quality of life, or plain EEG values. The findings suggest that the use of epiterra is highly promising in epileptology, particularly in FE and JME in adult patients.

Once the symptoms of multiple sclerosis (MS) occur, the risk of developing epilepsy within 5 years is 1.1%; this indicator doubles and triples 10 and 15 years after MS.Objective: to specify the epidemiology of MS in the Moscow Region and management tactics for patients with MS and epileptic seizures (ES). Patients and methods. Out of 906 patients diagnosed with MS, 9 (0.99%) (4 men and 5 women; mean age 28.62±4.59 years) were observed to have ES. The annual MS exacerbation rate was 1.2±1.19. Two MS patients were untreated for MS; 7 took MS-modifying drugs: interferonβ1a (n=2) or glatiramer acetate (n=5). The course of epilepsy and MS was retrospectively assessed. Two patient groups were identified: the first diagnosis was epilepsy (Group 1) and MS (Group 2). The patients were followed up jointly by a MS center physician and an epileptologist. If they had any indications, the patients underwent brain contrast-enhanced magnetic resonance imaging (MRI) (at least 1.5 T) and electroencephalography (EEG), EDSS health assessment, antiepileptic therapy (AET) analysis and correction. Results. The incidence rate of ES in MS patients is about 1%, which is 2.5 times greater than that for the adult population in the Moscow Region. ESs are accompanied by secondary generalization in more than 60% of the cases; serial and status convulsive seizures are recorded in one third of the patients. More than half of ES cases are associated with MS exacerbations.Conclusion. The use of AET after the first ESs is justified due to a high risk of recurrent seizures. Complete ES control can be achieved by AET as monotherapy in more than 70% of cases. If EP occurs, the patients with MS should undergo contrast-enhanced MRI of the brain to rule out an exacerbation.

Poststroke epileptic seizures are detected in 30–40% of patients over 60 years of age.Objective: to explore the clinical features of epileptic seizures in stroke, risk factors for their development to form the bases for prediction and elaboration of optimal therapy.Patients and methods. 468 patients with ischemic stroke were examined. A study group included 265 patients (176 men and 89 women) aged 31–89 years with epileptic seizures; a control group comprised 203 non-epileptic patients (126 men and 77 women) aged 31–91 years. The patients of both groups were matched for age, clinical characteristics, and pathogenetic subtypes of stroke. Instrumental examinations were performed in the attack-free interval. Neurological status was evaluated using the conventional procedure (the National Institute of Health Stroke Scale); brain magnetic resonance imaging (MRI), magnetic resonance angiography, electroencephalography, extraand transcranial duplex sound of cerebral vessels, by estimating the level and degree of stenosis and cerebrovascular responsiveness.Results and discussion. Focal seizures were noted to more frequently develop with a preponderance of simple partial seizures within the first 7 days of stroke, with neurological worsening in the acute period of the disease. Stroke in the left carotid and vertebrobasilar beds may provoke the development of early seizures. The cortical localization of ischemic foci and pre-stroke chronic brain ischemia with the signs of circulatory comorbidity in the anterior and posterior circulatory systems may be a risk factor of epileptic seizures. There was an association of the type of an epileptic seizure and the size of an ischemic focus, as evidenced by MRI, with a tendency towards the generalization of seizures in the extensive ischemic foci. A tendency toward the generalization of epileptic seizures was established in the development of stroke in the left carotid bed, as well as in critical stenoses and occlusions of the great cerebral vessels.

Objective: to study the specific features of epilepsy in children and adolescents with brain tumors and to define the optimal tactics of management and antiepileptic therapy after surgical treatment.Patients and methods. Sixty-one patients aged 5 months to 15 years were examined. All the patients were diagnosed as having a brain tumor found in the presence of symptomatic epilepsy. They were all followed up for 5 years postsurgery or during their lifetime (in case of death). Comprehensive examination encompassing the assessment of history data and concomitant complaints, brain magnetic resonance imaging, video-EEC monitoring, and the neurological status (the presence of cognitive impairments and eye ground changes) was done in all the cases. The probability of epileptic seizures in the clinical presentation of the disease, their semiology, and frequency were studied.Results and discussion. Epileptic seizures were the major complaint in all the patients at the first visit to their doctor. The disease occurred with status epilepticus in 9% of the patients. Different types of generalized seizures were more common (53%; p≥0.05). The tumor was located above the tentorium of the cerebellum in most examinees (77%) and beneath it in the others (23%; p≤0.05). The significant clinical sign of a brain tumor in the epileptic children is focal neurological symptoms (72% of the cases). MRI was performed in children who had no focal neurological symptoms in the late periods. There was cerebrospinal fluid hypertension in 51% of the patients (p≥0.05) and cognitive impairments in 33% (p<0.05). The maximum number (74%) of children with psycho-speech disorders and cognitive impairments were registered in the age group of 7–15 years. Eye ground changes characteristic of intracranial hypertension were identified in 19 epileptic children; they occurred in 27 patients more than 1 year after the onset of seizures. The late (few months-to-14 years) diagnosis of a brain tumor was stated in children with epileptic seizures. The diagnosis was established in patients with a tumor in the cerebral hemispheres in the later periods. The leading symptom in these children was epileptic seizures and EEG changes. The changes detectable by video-EEG monitoring with sleep inclusion were shown to be of diagnostic value.

CLINICAL OBSERVATIONS

The paper describes a clinical case of idiopathic generalized epilepsy with a variable phenotype, a similar type of epileptiform activity in the second stage of sleep, and a similar genotype in siblings. The onset of seizures was observed after closed brain injury in both cases. The sister had myoclonic seizures and her brother had generalized convulsive seizures late in the evening.

Idiopathic generalized epilepsy with generalized convulsive seizures appears as generalized tonic-clonic seizures on awakening. But in a number of cases, these seizures may occur when going to sleep. The brother has supposedly idiopathic generalized epilepsy with generalized tonicclonic seizures and his sister has juvenile myoclonic epilepsy, as indicated by her age, hereditary predisposition, phenobarbital-provoked seizures (the latter are also observed in his brother), an electrographic pattern, and the efficacy of Keppra and Topamax.

Cookies policy

The web-site of this journal uses cookies to optimize its performance and design as well as special service to collect and analyze data about pages visitors. By continuing to browse this web-site you agree to use cookies and the above service.